&OR\ J O l R\ 41,
DECEMBER IOU?. VOL 56,N O 6
Project Team investigates how the Association's organizational structure can be improved to meet future changes, challenges
A
ORN must be prepared to help perioperative nurses address changes in the US health cart delivery systems and their practices. The orgmizational htructiire must respond to changes that alread) have occurred and musf assume a proactive leadership position for fu t tire c hmge s. The Project Team to Develop a Model for the Association's Organizational Structure was charged by the AORY Board of Directors to assess the adequacy of the present organizational structure, as defined i n the bylaws. that will meet A O R N ' s current needs and those anticipated by the year 3000. The Project Team also assessed the impact of subspecialization in perioperative nursing on the adequacy of AORN's organizational structure. The Project Team specifically addressed AORN's relationship with state OR nurses' councils. mandatory chapter membership. and the national committee structure. A formal report from the Project Team was presented to the Board of Directon at its November meeting. Any recommendations will be published in the Pre-Congress .lorrrx~~I for discussion by inemberc at Conyess.
T
he present AORN policy regarding state councils does not recognize councils as par[ of AORY's formal structure. Councils are not permitted to portray themselves as representative\ of A O R N and are not authorized to use the A O R N logo. AORN Headquarters
keeps a list of known state councils, and that list is available on request. Although very few requests have been received at Headquarters about state councils, the Project Team members believe that AORN can assist the state councils in their activities. The Project Team's reaction panel (ie, 250 randomly chosen members) received a survey regarding AORN's relationship with state OR councils: 33% returned the survey. The results of that survey show that 67% of respondents agreed that state councils should be officially recognized by AORN, 66% agreed that state councils should be an integral part of AORN legislative activities. 5 4 8 stated that i t was appropriate to use AORN resources to help form state councils ( 2 I % disagreed, 21% were neutral), 37% of the respondents stated that there is a state council in their state, and 33% stated that there is not a state OR council in their state. T h e Project Team evaluated the survey results at its July 1992 meeting. In addition, the Project Team discussed other implications of AORN's relationship with state councils. Some of the issues discussed included the follow ing . If state councils were formally recognized by AORN, how would it affect AORN resources. efforts, and finances? How would AORN interact with states that do not have a council'?
AORN JOURNAL
How would AORN membership be affected? Should state councils be part of AORN’s formal structure? Should AORN become involved at the state level? What is meant by “officially recognize”? What is AORN willing to give? S h o u l d state councils have a c c e s s to AORN membership lists or labels? After discussing the role of state councils in AORN. the Project Team supports the current policy. The Project Team believes, however, that state councils should have access to membership lists and labels and should be able to apply for contact hours for educational activities through AORN. In addition, it would be helpful if state councils sent AORN information about council activities. This information would be kept on file for other chapters in other states who may request that information. (State councils are encouraged to send information to Pat Palmer, RN, MS, deputy executive director, AORN Headquarters, 2170 S Parker Rd, Suite 300, Denver, CO 80231-57 1 1 .) The members of the Project Team agreed that state councils are an important communication link between chapters within a state. Therefore, the Project Team believes that increased communication with AORN Headquarters would be beneficial for everyone. This increased communication, however, would not cause a major shift in Association governance, which rests with the chapter delegates.
Mandatory Chuptei. Membership
S
ome members have expressed dissatisfaction with the current policy that states that chapter membership is mandatory if the member lives within a 50-mile radius of a chapter. In response. the Project Team investigated voluntary versus mandatory chapter membership. The Project Team gathered information from the advisory and reaction panels and discussed the issue i n depth. The Project Team determined that chapter membership
DECEMBER 1992. VOL 56, NO 6
provides a networking opportunity at the local level, provides an arena for grooming future national leaders, provides income for the chapter, increases the chapter membership base for determining the number of delegates to Congress, provides educational activities, and strengthens national AORN. As with all Project 2000 recommendations, any formal recommendation regarding this issue m u s t be a p p r o v e d by t h e Board of Directors and will be presented to the members for discussion and input.
National Committee Structure
A
fter studying other organizational structures, the members of the Project Team identified the need for meaningful volunteer input and ways to balance that need with meinhers’ other time commitments. The goal was to avoid wasting precious volunteer time on inefficient committees. The Project Team members also evaluated Headquarters staff activities and separated those activities from those that must come from members. After further research and debate, the Project Team developed a new concept of how the national committee structure could be improved. Present committee structure. There are now nine AORN national standing committees as defined in the bylaws: Audiovisual Committee, 0 Award for Excellence in Perioperative Nursing Committee, Bylaws Committee, Legislative Committee, Membership Committee, National Committee on Education, 0 Nursing Practices Committee, 0 Nursing Research Committee, and 0 Recommended Practices Coordinating Committee. In addition, the bylaws provide f o r the appointment of special committees as deemed
DECEMBER 1992, VOL 56, NO 6
AORN JOURNAL
The Project Team believes the present structure will not efficiently address the complex issues of the future. necessary by the Board of Directors. Current special committees include RN First Assistant Task Force, Scholarship Board, Special Committee on Human Immunodeficiency Virus (HIV), Special Committee on Environmental Issues, Special Committee on Ethics, and Standards and Recommended Practices Publication Special Committee. Two of the special committees (ie, RN First Assistant Task Force, Standards and Recommended Practices Publication Special Committee) are short-term committees. The Special Committee on Human Immunodeficiency Virus (HIV) may disband as well if its charge is assumed by the Special Committee on Ethics. I n addition, the Project 2000 structure includes the Project 2000 Steering Committee and four Project Teams. This structure is intended to be “time limited,” depending on the progress of the projects. A total of 140 AORN member volunteers are now involved on the Board of Directors or committees or as AORN liaisons to other organizations. Of these, I7 were elected by the membership, and the remainder were appointed by the President with Board ratification. Thirteen of those appointments are leadership positions (ie, committee chairmen, liaisons to other organizations). Appointments are reaffirmed annually, and it is generally understood that most committee terms last two years. The appointment process is very time consuming and requires much staff support in the communication process. Of all the groups listed above, 22 are accountable to the Board of Directors, six of which are committees of the Board. The Board spends a considerable amount of time monitoring the work of these committees. The Board’s
major responsibilities are to focus on the future of the organization and provide a strong strategic and financial plan for attaining set goals. The present structure does not provide an easy way to access members who are qualified experts to address specific issues that continue to arise. Several of the committees have overlapping responsibilities, which require intercommittee coordination and Board approval before any action is taken. The members of the Project Team believe the present structure will not efficiently address the complex issues of the year 2000. Alternative structure. The Project Team to Develop a Model for the Association’s Organizational Structure has investigated many association models. Among the alternatives to a committee structure is a cabinet structure in which cabinets serve as “umbrellas” for committee functions. In AORN’s case, the cabinets could include education, practice, health policy issues, and Association affairs. The responsibilities of each cabinet would be identified so the work of the present committees is not lost. For example, a cabinet on education could be responsible for production of timely education materials that meet the needs of members (eg, videotapes, books, computer-assisted instruction, seminars, graduate programs, peer review of educational activities for contact hours). A cabinet on nursing practice may be responsible for ongoing assessment of nursing practice, research, ethics, and standards and recommended practices. A cabinet on health policy issues would be responsible for identifying state and national legislative and government regulatory issues, legislative priorities, and environmental issues. A cabinet on Association affairs could coordinate awards, review bylaws, solve credentialing conflicts, and deal with membership activities. 1037
A O K Y .JOLR\AL
DECEMBER 1992. VOL 56, NO 6
Table 1
Reaction Panel Responses to National Cabinet System Survey statement
9i Agreed
9i Neutral 5% Disagreed
A cabinet structure would increase the number of members who could participate at the national level.
85
1s
0
A cabinet structure would facilitate more productive results and less duplication of efforts.
84
16
0
The 24 members of the cabinets should be appointed by the AORN President and approved by the Board.
59
34
6
The Lvork groups needed to carry out the charges of each cabinet should be appointed by the cabinet.
91
9
0
Do you agree that implementation of a cabinet system could begin in 1995 and conclude by 2000?
85
13
3
The current AORN committee structure should not be changed.*
12
16
66
+:;Six percent of the respondents did not answer this survey question.
The Prqject Team's investigations indicate that a cabinet structure would increase the number of opportunities for volunteer involvement on the national level. Each cabinet appointment would be a key leadership position (similar to a committee chairinan ), and the number of those appointments would increase from 13 to 24 (ie. six per cabinet). Each cabinet would use "conwltants" t similar to present committee menihers) to accomplish its charge. An average of 10 t o 25 consultants on each cabinet would bring volunteer opportunities to the present level. These consultants could serve short-term assignments. specializing in their areas of expertise. This would increase opportunities for more members to participate, especially those
inembers whose responsibilities do not permit a long-tern1 commitment. Each cabinet would be composed of six AORN members appointed by the President and ratified by the Board for three-year terms. Those six members would be empowered to appoint their own consultants to accomplish the cabinet's charge. For example, a cabinet on nursing practice may be charged with developing a statement or recommended practice on the care of a patient with multi-drug resistant tuberculosis. The cabinet leaders would decide who in AORN's membership could lend their expertise to that charge and could convene a shortterm working group of experts to accomplish that goal.
AORN JOURNAL
DECEMBER 1992, VOL 56, NO 6
Benefits. The Project Team believes that a cabinet structure would allow AORN to be proactive in meeting the needs of members in many ways. The process of doing business would be streamlined because four cabinets would report to the Board instead of the present 15 committees. The concept of self-govemance would be encouraged because cabinet members would be empowered to appoint consultants, as opposed to one person making all the appointments. Future leaders would be mentored. Members could feel free to identify their areas of expertise and communicate directly with all cabinets. 0 More AORN members potentially could be involved on the national level because of the short-term working groups. 0 Staff support to the volunteer groups would be facilitated because each cabinet would have one director at Headquarters who would facilitate the cabinet’s work. Broader decision-making authority would allow the cabinets to delegate work, make decisions, and report those decisions to the Board, instead of requesting Board permission for each step of the process. The potential for overlapping work would be recognized, and the cabinet members would be attuned to coordinating those efforts. Reaction. Results of a reaction panel survey regarding the cabinet structure indicate that the respondents would approve of such a structure. Table 1 shows the percent of agreement, neutrality, or disagreement with the statements on the survey. Responses from the advisory committee were parallel. The reaction panel members also were asked what label should be used for the new structure. The panel members chose the terms councils (31%), cabinets (28%), divisions (16%), and commissions (3%), and 22% had no preference. Summary. The members of the Project Team realize that this is a very different concept than
that to which members are accustomed. The details of such a change would be developed with member input, and the new structure would be phased in over a period of several years to be fully implemented by the year 2000.
Conclusion
T
his information is being presented only as ideas for thought and discussion at this time. If the Project Team makes any formal recommendations concerning any of these issues, they will go to the Project 2000 Steering Committee first and then to the Board of Directors. Any proposed change in policy will be published in the pre-Congress issue of the AORN Journal and will be presented at Congress for discussion by the members. RN, MS, MBA, CNOR, JOYDONBAKER, CNA, CHAIRMAN KAYA. BALL,RN, MSA, CNOR LOLAM. FEHR,RN, MS, CAE PATPALMER, RN, MS VICKIE E. PIERCE, RN, BSN, CNOR RUTHP. SHUMAKER, RN, CNOR CYNTHIA C. SPRY,RN, MA, MSN, CNOR BARBARA GRUENDEMANN, RN, MS, FAAN, TO STEERING COMMITTEE LIAISON JODYFOSS, RN, MS, STAFF CONSULTANT PROJECT TEAMTO DEVELOP A MODEL FOR THE ASSOCIATION’S ORGANIZATIONAL STRUCTURE
1039
DECEMBER IOU?. VOL 56,N O 6
Project Team investigates how the Association's organizational structure can be improved to meet future changes, challenges
A
ORN must be prepared to help perioperative nurses address changes in the US health cart delivery systems and their practices. The orgmizational htructiire must respond to changes that alread) have occurred and musf assume a proactive leadership position for fu t tire c hmge s. The Project Team to Develop a Model for the Association's Organizational Structure was charged by the AORY Board of Directors to assess the adequacy of the present organizational structure, as defined i n the bylaws. that will meet A O R N ' s current needs and those anticipated by the year 3000. The Project Team also assessed the impact of subspecialization in perioperative nursing on the adequacy of AORN's organizational structure. The Project Team specifically addressed AORN's relationship with state OR nurses' councils. mandatory chapter membership. and the national committee structure. A formal report from the Project Team was presented to the Board of Directon at its November meeting. Any recommendations will be published in the Pre-Congress .lorrrx~~I for discussion by inemberc at Conyess.
T
he present AORN policy regarding state councils does not recognize councils as par[ of AORY's formal structure. Councils are not permitted to portray themselves as representative\ of A O R N and are not authorized to use the A O R N logo. AORN Headquarters
keeps a list of known state councils, and that list is available on request. Although very few requests have been received at Headquarters about state councils, the Project Team members believe that AORN can assist the state councils in their activities. The Project Team's reaction panel (ie, 250 randomly chosen members) received a survey regarding AORN's relationship with state OR councils: 33% returned the survey. The results of that survey show that 67% of respondents agreed that state councils should be officially recognized by AORN, 66% agreed that state councils should be an integral part of AORN legislative activities. 5 4 8 stated that i t was appropriate to use AORN resources to help form state councils ( 2 I % disagreed, 21% were neutral), 37% of the respondents stated that there is a state council in their state, and 33% stated that there is not a state OR council in their state. T h e Project Team evaluated the survey results at its July 1992 meeting. In addition, the Project Team discussed other implications of AORN's relationship with state councils. Some of the issues discussed included the follow ing . If state councils were formally recognized by AORN, how would it affect AORN resources. efforts, and finances? How would AORN interact with states that do not have a council'?
AORN JOURNAL
How would AORN membership be affected? Should state councils be part of AORN’s formal structure? Should AORN become involved at the state level? What is meant by “officially recognize”? What is AORN willing to give? S h o u l d state councils have a c c e s s to AORN membership lists or labels? After discussing the role of state councils in AORN. the Project Team supports the current policy. The Project Team believes, however, that state councils should have access to membership lists and labels and should be able to apply for contact hours for educational activities through AORN. In addition, it would be helpful if state councils sent AORN information about council activities. This information would be kept on file for other chapters in other states who may request that information. (State councils are encouraged to send information to Pat Palmer, RN, MS, deputy executive director, AORN Headquarters, 2170 S Parker Rd, Suite 300, Denver, CO 80231-57 1 1 .) The members of the Project Team agreed that state councils are an important communication link between chapters within a state. Therefore, the Project Team believes that increased communication with AORN Headquarters would be beneficial for everyone. This increased communication, however, would not cause a major shift in Association governance, which rests with the chapter delegates.
Mandatory Chuptei. Membership
S
ome members have expressed dissatisfaction with the current policy that states that chapter membership is mandatory if the member lives within a 50-mile radius of a chapter. In response. the Project Team investigated voluntary versus mandatory chapter membership. The Project Team gathered information from the advisory and reaction panels and discussed the issue i n depth. The Project Team determined that chapter membership
DECEMBER 1992. VOL 56, NO 6
provides a networking opportunity at the local level, provides an arena for grooming future national leaders, provides income for the chapter, increases the chapter membership base for determining the number of delegates to Congress, provides educational activities, and strengthens national AORN. As with all Project 2000 recommendations, any formal recommendation regarding this issue m u s t be a p p r o v e d by t h e Board of Directors and will be presented to the members for discussion and input.
National Committee Structure
A
fter studying other organizational structures, the members of the Project Team identified the need for meaningful volunteer input and ways to balance that need with meinhers’ other time commitments. The goal was to avoid wasting precious volunteer time on inefficient committees. The Project Team members also evaluated Headquarters staff activities and separated those activities from those that must come from members. After further research and debate, the Project Team developed a new concept of how the national committee structure could be improved. Present committee structure. There are now nine AORN national standing committees as defined in the bylaws: Audiovisual Committee, 0 Award for Excellence in Perioperative Nursing Committee, Bylaws Committee, Legislative Committee, Membership Committee, National Committee on Education, 0 Nursing Practices Committee, 0 Nursing Research Committee, and 0 Recommended Practices Coordinating Committee. In addition, the bylaws provide f o r the appointment of special committees as deemed
DECEMBER 1992, VOL 56, NO 6
AORN JOURNAL
The Project Team believes the present structure will not efficiently address the complex issues of the future. necessary by the Board of Directors. Current special committees include RN First Assistant Task Force, Scholarship Board, Special Committee on Human Immunodeficiency Virus (HIV), Special Committee on Environmental Issues, Special Committee on Ethics, and Standards and Recommended Practices Publication Special Committee. Two of the special committees (ie, RN First Assistant Task Force, Standards and Recommended Practices Publication Special Committee) are short-term committees. The Special Committee on Human Immunodeficiency Virus (HIV) may disband as well if its charge is assumed by the Special Committee on Ethics. I n addition, the Project 2000 structure includes the Project 2000 Steering Committee and four Project Teams. This structure is intended to be “time limited,” depending on the progress of the projects. A total of 140 AORN member volunteers are now involved on the Board of Directors or committees or as AORN liaisons to other organizations. Of these, I7 were elected by the membership, and the remainder were appointed by the President with Board ratification. Thirteen of those appointments are leadership positions (ie, committee chairmen, liaisons to other organizations). Appointments are reaffirmed annually, and it is generally understood that most committee terms last two years. The appointment process is very time consuming and requires much staff support in the communication process. Of all the groups listed above, 22 are accountable to the Board of Directors, six of which are committees of the Board. The Board spends a considerable amount of time monitoring the work of these committees. The Board’s
major responsibilities are to focus on the future of the organization and provide a strong strategic and financial plan for attaining set goals. The present structure does not provide an easy way to access members who are qualified experts to address specific issues that continue to arise. Several of the committees have overlapping responsibilities, which require intercommittee coordination and Board approval before any action is taken. The members of the Project Team believe the present structure will not efficiently address the complex issues of the year 2000. Alternative structure. The Project Team to Develop a Model for the Association’s Organizational Structure has investigated many association models. Among the alternatives to a committee structure is a cabinet structure in which cabinets serve as “umbrellas” for committee functions. In AORN’s case, the cabinets could include education, practice, health policy issues, and Association affairs. The responsibilities of each cabinet would be identified so the work of the present committees is not lost. For example, a cabinet on education could be responsible for production of timely education materials that meet the needs of members (eg, videotapes, books, computer-assisted instruction, seminars, graduate programs, peer review of educational activities for contact hours). A cabinet on nursing practice may be responsible for ongoing assessment of nursing practice, research, ethics, and standards and recommended practices. A cabinet on health policy issues would be responsible for identifying state and national legislative and government regulatory issues, legislative priorities, and environmental issues. A cabinet on Association affairs could coordinate awards, review bylaws, solve credentialing conflicts, and deal with membership activities. 1037
A O K Y .JOLR\AL
DECEMBER 1992. VOL 56, NO 6
Table 1
Reaction Panel Responses to National Cabinet System Survey statement
9i Agreed
9i Neutral 5% Disagreed
A cabinet structure would increase the number of members who could participate at the national level.
85
1s
0
A cabinet structure would facilitate more productive results and less duplication of efforts.
84
16
0
The 24 members of the cabinets should be appointed by the AORN President and approved by the Board.
59
34
6
The Lvork groups needed to carry out the charges of each cabinet should be appointed by the cabinet.
91
9
0
Do you agree that implementation of a cabinet system could begin in 1995 and conclude by 2000?
85
13
3
The current AORN committee structure should not be changed.*
12
16
66
+:;Six percent of the respondents did not answer this survey question.
The Prqject Team's investigations indicate that a cabinet structure would increase the number of opportunities for volunteer involvement on the national level. Each cabinet appointment would be a key leadership position (similar to a committee chairinan ), and the number of those appointments would increase from 13 to 24 (ie. six per cabinet). Each cabinet would use "conwltants" t similar to present committee menihers) to accomplish its charge. An average of 10 t o 25 consultants on each cabinet would bring volunteer opportunities to the present level. These consultants could serve short-term assignments. specializing in their areas of expertise. This would increase opportunities for more members to participate, especially those
inembers whose responsibilities do not permit a long-tern1 commitment. Each cabinet would be composed of six AORN members appointed by the President and ratified by the Board for three-year terms. Those six members would be empowered to appoint their own consultants to accomplish the cabinet's charge. For example, a cabinet on nursing practice may be charged with developing a statement or recommended practice on the care of a patient with multi-drug resistant tuberculosis. The cabinet leaders would decide who in AORN's membership could lend their expertise to that charge and could convene a shortterm working group of experts to accomplish that goal.
AORN JOURNAL
DECEMBER 1992, VOL 56, NO 6
Benefits. The Project Team believes that a cabinet structure would allow AORN to be proactive in meeting the needs of members in many ways. The process of doing business would be streamlined because four cabinets would report to the Board instead of the present 15 committees. The concept of self-govemance would be encouraged because cabinet members would be empowered to appoint consultants, as opposed to one person making all the appointments. Future leaders would be mentored. Members could feel free to identify their areas of expertise and communicate directly with all cabinets. 0 More AORN members potentially could be involved on the national level because of the short-term working groups. 0 Staff support to the volunteer groups would be facilitated because each cabinet would have one director at Headquarters who would facilitate the cabinet’s work. Broader decision-making authority would allow the cabinets to delegate work, make decisions, and report those decisions to the Board, instead of requesting Board permission for each step of the process. The potential for overlapping work would be recognized, and the cabinet members would be attuned to coordinating those efforts. Reaction. Results of a reaction panel survey regarding the cabinet structure indicate that the respondents would approve of such a structure. Table 1 shows the percent of agreement, neutrality, or disagreement with the statements on the survey. Responses from the advisory committee were parallel. The reaction panel members also were asked what label should be used for the new structure. The panel members chose the terms councils (31%), cabinets (28%), divisions (16%), and commissions (3%), and 22% had no preference. Summary. The members of the Project Team realize that this is a very different concept than
that to which members are accustomed. The details of such a change would be developed with member input, and the new structure would be phased in over a period of several years to be fully implemented by the year 2000.
Conclusion
T
his information is being presented only as ideas for thought and discussion at this time. If the Project Team makes any formal recommendations concerning any of these issues, they will go to the Project 2000 Steering Committee first and then to the Board of Directors. Any proposed change in policy will be published in the pre-Congress issue of the AORN Journal and will be presented at Congress for discussion by the members. RN, MS, MBA, CNOR, JOYDONBAKER, CNA, CHAIRMAN KAYA. BALL,RN, MSA, CNOR LOLAM. FEHR,RN, MS, CAE PATPALMER, RN, MS VICKIE E. PIERCE, RN, BSN, CNOR RUTHP. SHUMAKER, RN, CNOR CYNTHIA C. SPRY,RN, MA, MSN, CNOR BARBARA GRUENDEMANN, RN, MS, FAAN, TO STEERING COMMITTEE LIAISON JODYFOSS, RN, MS, STAFF CONSULTANT PROJECT TEAMTO DEVELOP A MODEL FOR THE ASSOCIATION’S ORGANIZATIONAL STRUCTURE
1039
